Provider Demographics
NPI:1326446667
Name:MICHELS, ROBERTA (AUD)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:MICHELS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2402
Mailing Address - Country:US
Mailing Address - Phone:734-281-4197
Mailing Address - Fax:734-282-0093
Practice Address - Street 1:14500 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2402
Practice Address - Country:US
Practice Address - Phone:734-281-4197
Practice Address - Fax:734-282-0093
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000672231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist